Glyburide increases cytosolic-free calcium concentrations in normal rat pancreatic islet cells

Hexose metabolism in pancreatic islets. Regulation of D-[6-14C]glucose oxidation by non-nutrient secretagogues

In rat pancreatic islets, a rise in D-glucose concentrations increases the oxidation of hexose-derived acetyl residues relative to glycolytic flux, an effect possibly attributable, in part at least, to the activation of key mitochondrial dehydrogenases by Ca2+ accumulated in the mitochondria of glucose-stimulated islet cells. The effects of non-nutrient insulinotropic agents upon D-[6-14C]glucose oxidation and D-[5-3H]glucose utilization were investigated. At an intermediate concentration of D-glucose (6 mM), the oxidation of D-[6-14C]glucose was unaffected by hypoglycemic sulfonylureas, an organic Ca2+ agonist, a cholinergic agent, forskolin, theophylline and cytochalasin B. At a higher concentration of the hexose (17 mM), however, the 14CO2/3H2O production rate was decreased by organic and inorganic Ca(2+)-antagonists and by ouabain, whilst being increased by NH+4 (10 mM) and aminooxyacetate. These findings suggest that the preferential stimulation of oxidative events in the Krebs cycle is largely independent of the rate of insulin release, and not merely consequential to the stimulation of Ca2+ inflow into the B-cell. It might be regulated, in a feedback process, by the rate of ATP utilization and, both directly and indirectly, by the mitochondrial redox state. The glucose-induced mitochondrial accumulation of Ca2+ and subsequent activation of the Krebs cycle appear to require an increase in both cytosolic Ca2+ activity and ATP availability.

Effect of glyburide on beta cell responsiveness to glucose in non-insulin-dependent diabetes mellitus

Since the introduction of glyburide in 1984, many studies have evaluated the effects of this oral hypoglycemic agent on beta cell function in patients with non-insulin-dependent diabetes mellitus. The early studies, which were performed in patients receiving concomitant insulin therapy, may have underestimated the true effect of glyburide on insulin secretion. The more recent studies demonstrate that both short- and long-term glyburide therapy increase C-peptide levels in diabetic as well as nondiabetic subjects and that the effects of glyburide are comparable to those of the other second-generation sulfonylurea, glipizide. The effects of glyburide on insulin secretory rates calculated from plasma C-peptide levels were recently evaluated using individually derived C-peptide kinetic parameters and a validated open two-compartment model of peripheral C-peptide kinetics. Glyburide did not influence fasting insulin secretion (196 +/- 34 versus 216 +/- 23 pmol/min) but did cause an increase in the total amount of insulin secreted over a 24-hour period (447 +/- 58 versus 561 +/- 55 nmol). This increase in the production of insulin was generated by an increase in amplitude of secretory pulses occurring after lunch and dinner rather than by a greater number of pulses. The full effect of glyburide on the beta cell became evident when glucose concentrations were clamped at the hyperglycemic level of 300 mg/dL both before and during treatment for a 3-hour period. During that time, insulin secretion rates increased by 221 percent in response to glyburide. Glyburide did not, however, completely reverse the beta cell secretory defect characteristic of non-insulin-dependent diabetes mellitus. In the patients receiving glyburide, the sluggish insulin secretory response to breakfast persisted, and the insulin secretory response during the hyperglycemic clamping was less than the response normally seen in nondiabetic subjects. These experiments suggest that the primary effect of glyburide on the beta cell is to increase its responsiveness to glucose. Although the precise mechanism of action of glyburide at the cellular level is unclear, in vitro studies suggest that its effect is mediated through binding with specific receptors on the beta cell membrane, which in turn leads to alterations in the cellular efflux of potassium ions and influx of calcium ions.

Intracellular calcium, insulin secretion, and action

Changes in cytosolic free calcium concentration [( Ca2+]i) constitute an important element of signal transduction in various cells. These changes either reflect alterations in calcium (Ca2+) fluxes or result from mobilization of intracellular Ca2+ stores. In pancreatic islet cells, an increase in [Ca2+]i is critical for secretagogue-induced insulin release. Thus, glucose evokes a rapid increase in [Ca2+]i, primarily by stimulating Ca2+ influx. Under physiologic conditions, glucose may also promote mobilization of intracellular Ca2+ stores by virtue of stimulating membrane phospholipid hydrolysis and formation of inositol triphosphate, a potent stimulus for Ca2+ mobilization. This action of glucose requires the presence of extracellular Ca2+. The magnitude of change in [Ca2+]i may not parallel the level of insulin release, suggesting that the role of [Ca2+]i in the process of insulin release must be considered in concert with other cellular mechanisms. The role of [Ca2+]i in promoting insulin action is a subject of continuous controversy. Recent observations that chelation of intracellular Ca2+ with quin-2 diminishes insulin action (and that of insulin mimetics) support the role of Ca2+ in mediating the insulin-generated signal. Insulin has also been demonstrated to increase [Ca2+]i in adipocytes in close association with its effect on 2-deoxyglucose uptake. Finally, in both pancreatic islet cells and adipocytes, high concentrations of either extracellular or intracellular Ca2+ inhibit cellular responsiveness. The optimal concentrations of cytosolic Ca2+ appear to be within the 140 to 350 nM range. When Ca2+ concentrations are too low or too high, the ability of pancreatic islets and insulin target cells to respond appropriately to physiologic stimuli is significantly diminished. Impaired cellular Ca2+ homeostasis (either primary or secondary to other cellular lesions) may represent a crucial and identical link in the pathogenesis of impaired insulin secretion and in the pathogenesis of impaired insulin action.